OBJECTIVE: To report neural plasticity changes after severe traumatic brain
injury.
SETTING: Case-control study.
PARTICIPANTS: Canadian soldier, Captain Trevor Greene survived a severe
open-traumatic brain injury during a 2006 combat tour in Afghanistan.
DESIGN: Longitudinal follow-up for more than 6 years.
MAIN MEASURES: Twelve longitudinal functional magnetic imaging (fMRI)
examinations were conducted to investigate lower limb activation changes in
association with clinical examination. Trevor Greene's lower limb fMRI activation
was compared with control fMRI activation of (1) mental imagery of similar
movement and (2) matched control subject data.
RESULTS: Trevor Greene's motor recovery and corresponding fMRI activation
increased significantly over time (F = 32.54, P < .001). Clinical measures of
functional recovery correlated strongly with fMRI motor activation changes (r =
0.81, P = .001). By comparison, while Trevor Greene's mental imagery activated
similar motor regions, there was no evidence of fMRI activation change over time.
While comparable, control motor activation did not change over time and there was
no significant mental imagery activation.
CONCLUSION: Motor function recovery can occur beyond 6 years after severe
traumatic brain injury, both in neural plasticity and clinical outcome. This
demonstrates that continued benefits in physical function due to rehabilitative
efforts can be achieved for many years following injury. The finding challenges
current practices and assumptions in rehabilitation following traumatic brain
injury.